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1. DELIRIUM

2. WHAT’S DELIRIUM???
 Delirium is the most common behavioral disorder in
a medical-surgical setting. Delirium is an acute
mental status change characterized by abnormal
and fluctuating attention
 Delirium may be the only sign of a serious or life
threatening medical condition and is a common
manifestation of acute illness among older people

3. CLINICAL FEATURES
 Acute onset of mental status change with
fluctuating course
 Attention deficits
 Disorganized thinking
 Altered level of consciousness
 Perceptual disturbances
 Disturbed sleep-wake cycle
 Altered psychomotor activity
 Disorientation and memory impairment
 Other cognitive deficits
 Behavioral and emotional abnormalities

4. DSM-IV (DIAGNOSTIC CRITERIA FOR
DELIRIUM)
 Disturbance of consciousness (i.e., reduced clarity of
awareness of the environment) with reduced ability to
focus, sustain, or shift attention.
 A change in cognition (such as memory deficit,
disorientation, language disturbance) or the
development of a perceptual disturbance that is not
better accounted for by pre-existing, established, or
evolving dementia.
 The disturbance develops over a short period (usually
hours to days) and tends to fluctuate during the course
of the day.
 There is evidence from the history, physical
examination, or laboratory findings that the disturbance
is caused by the direct physiological consequences of a
general medical condition.

5. CONFUSION ASSESSMENT METHOD (CAM)
 1. Acute onset and fluctuating course (mental status
changes from hours to days)
 2. Difficulty in focusing (easily distracted, unable to
follow interview)
 3. Disorganized thinking (rambling, irrelevant
conversation)
 4. Altered level of consciousness (from hyper alert
to decreased arousal)
 A positive CAM test for delirium requires items 1
and 2 plus either item 3 or item 4).